$2,527.00 a month for severe post-traumatic stress disorder
compensation is not too bad, especially if such disability payments
are increased annually to offset cost-of-living increases.

But the scandal-plagued VA might have its hands full tamping down
public outrage with this latest caper.

-----------------------------
"Official Urged Fewer Diagnoses of PTSD"

By Christopher Lee
Washington Post Staff Writer
Friday, May 16, 2008; A02

A psychologist who helps lead the post-traumatic stress disorder
program at a medical facility for veterans in Texas told staff members
to refrain from diagnosing PTSD because so many veterans were seeking
government disability payments for the condition.

"Given that we are having more and more compensation seeking veterans,
I'd like to suggest that you refrain from giving a diagnosis of PTSD
straight out," Norma Perez wrote in a March 20 e-mail to mental-health
specialists and social workers at the Department of Veterans Affairs'
Olin E. Teague Veterans' Center in Temple, Tex. Instead, she
recommended that they "consider a diagnosis of Adjustment Disorder."

VA staff members "really don't . . . have time to do the extensive
testing that should be done to determine PTSD," Perez wrote.

Adjustment disorder is a less severe reaction to stress than PTSD and
has a shorter duration, usually no longer than six months, said
Anthony T. Ng, a psychiatrist and member of Mental Health America, a
nonprofit professional association.

Veterans diagnosed with PTSD can be eligible for disability
compensation of up to $2,527 a month, depending on the severity of the
condition, said Alison Aikele, a VA spokeswoman. Those found to have
adjustment disorder generally are not offered such payments, though
veterans can receive medical treatment for either condition.

Perez's e-mail was obtained and released publicly yesterday by
VoteVets.org, a veterans group that has been critical of the Bush
administration's policies in Iraq and Afghanistan, and Citizens for
Responsibility and Ethics in Washington (CREW), a nonprofit government
watchdog group.

"Many veterans believe that the government just doesn't want to pay
out the disability that comes along with a PTSD diagnosis, and this
revelation will not allay their concerns," John Soltz, chairman of
VoteVets.org and an Iraq war veteran, said in a statement.

Melanie Sloan, executive director of CREW, said in a statement: "It is
outrageous that the VA is calling on its employees to deliberately
misdiagnose returning veterans in an effort to cut costs. Those who
have risked their lives serving our country deserve far better."

Veterans Affairs Secretary James B. Peake said in a statement that
Perez's e-mail was "inappropriate" and does not reflect VA policy. It
has been "repudiated at the highest level of our health care
organization," he said.

"VA's leadership will strongly remind all medical staff that trust,
accuracy and transparency is paramount to maintaining our
relationships with our veteran patients," Peake said.

Peake said Perez has been "counseled" and is "extremely apologetic."
Aikele said Perez remains in her job.

A Rand Corp. report released in April found that repeated exposure to
combat stress in Iraq and Afghanistan is causing a disproportionately
high psychological toll compared with physical injuries. About 300,000
U.S. military personnel who have served in Iraq or Afghanistan are
suffering from PTSD or major depression, the study found. The economic
cost to the United States -- including medical care, forgone
productivity and lost lives through suicide -- is expected to reach $4
billion to $6 billion over two years.

Ng said diagnosing PTSD often requires observing a patient for weeks
or months because the condition implies a long, lingering effect of
stress.

"Most people exposed to trauma, in general, can get better," Ng said.
"You don't want to over-diagnose people with PTSD. Whether it's
adjustment disorder is one thing. It's usually a temporary disorder
with severity that is not as bad as someone with full-blown PTSD."

http://www.washingtonpost.com/wp-dyn/content/article/2008/05/15/AR200...